J. Matthews Duncan’s On the Mortality of Childbed and Maternity Hospitals

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting them on Wednesdays to coincide with the schedule of his old BMJ column. We hope you enjoy them.

Anyone who shares with me the strange desire to buy and possess old books will have noticed that many of them now on sale come from the collections of public institutions or learned societies. So it was with On the Mortality of Childbed and Maternity Hospitals, by J. Matthews Duncan, published in 1870, that I bought recently. It had formerly belonged to the library of the Royal College of Surgeons in Ireland.

The need for space, the advances of digitisation, and the fact that many books are no longer consulted by anyone, are the reasons the librarians give for what is known as deacquisitioning. In the case of this book, it is true that no one had consulted it for more than 140 years: I know this because its pages were still uncut.

In fact, Duncan (1826 – 1890) was a considerable figure in his day; when he died, Queen Victoria told his widow that “the country and Europe at large have lost one of their most distinguished men.” He is regarded as one of the founders of the statistical study of fecundity and sterility.

On the Mortality of Childbed makes very interesting reading. Although there is much about puerperal fever, the name of Semmelweis is not mentioned in it. Indeed, Duncan did not believe that the fever was either epidemic or infective. Having demonstrated that it was twice as common in primiparae as in multiparae, at all ages, except after the birth of the ninth child, he wrote:

I shall not enter further than to say that the occurrence of puerperal fever specially among primiparae, and women who have borne large families, – its pretty close correspondence in relative amount to the general mortality of parturition after different pregnancies – its subjection also to the law of the duration of labour [that the longer the labour, the greater the mortality], – do not appear to me to lend support to the views hitherto generally entertained regarding it, and expressed in the words accidental, fever, contagious, epidemic.

Duncan was an early collaborator of James Young Simpson, the discoverer of chloroform, and indeed took part in the famous party when Simpson demonstrated the effects of the new anaesthetic; but in this book Duncan loses no opportunity to take his old boss to task, particularly for his assertion that large hospitals are more dangerous than small. He derides Simpson for his assertion, “on deceitful grounds,” and using statistics that “are really so insecure as to be quite worthless,” that the mortality in childbed had declined from one in 44 in 1680, to “only” one in 107 in 1820, thanks to supposed advances in obstetric practice.

Simpson, who died in the year the book was published, had his posthumous revenge. Duncan was widely expected to follow him as Professor of Obstetrics, but Simpson’s nephew, Alexander Russell Simpson, was elected to it instead. Duncan then moved to London.

In the book, Duncan defended maternity hospitals against the attack of a French writer called Le Fort, who claimed that one in 29 women who gave birth in them died (at the Charité it was one in 7). All that this showed, said Duncan, was “how bad they may be, and little more.” The figure for the Dublin Maternity Hospital, for 190,000 births over a century, was one in 72.

Duncan did very well financially. He left an estate of £86,436 11s. 8d., the equivalent, perhaps, of between £5and £8 million in our money.